Various Sexually Transmitted Infections

Gonorrhea
Gonorrhea (or “Clap”) is an infectious sexually transmitted infection that chiefly affects the mucous membrane of the urogenital tract, the rectum, and occasionally the eyes. The disease is caused by gonococci and belongs to the genera of Neisseria. Discharges from the involved mucous membranes are the source of infection and the bacteria are transmitted by direct contact, usually sexual or during passage of a newborn through the birth canal.In Males
Usually suffer inflammation of the urethra with pus and painful urination. Fibrosis sometimes occurs in an advanced stage, causing narrowing of the urethra. There also may be involvement of the epididymis and prostate gland.In Females
Infection may occur in the urethra, vagina, and cervix, and there may be a discharge of pus. However, infected females often harbor the disease without any symptoms until it has progressed to a more advanced stage. If the uterine (Fallopian) tubes become involved, pelvic inflammation may follow. Peritonitis, or inflammation of the peritoneum, is a very serious disorder. The infection should be treated and controlled immediately because, if neglected, sterility or death may result. Although antibiotics have greatly reduced the mortality rate of acute peritonitis, it is estimated that between 50,000 and 80,000 women are made sterile by gonorrhea every year as a result of scar tissue formation that closes the uterine tubes. If the bacteria are transmitted to the eyes of the newborn in the birth canal, blindness can result.

Treatment of Gonorrhea
Abstinence from coitus until the infection is eradicated. Patients are advised bed–rest and analgesics. Various antibiotics are prescribed.

Syphilis
Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum. The highest incidence is in the 20 to 39 years old age group. It is acquired through sexual contact or transmitted through the placenta to a fetus. The disease progresses through several stages: primary, secondary, latent, and sometimes tertiary.Primary Stage
During the primary stage, the chief symptom is an open sore, called a chancre (pronounced SHANKG–ker), at the point of contact. The chancre heals within one to five weeks.Secondary Stage
In secondary stage, from 6 to 24 weeks later, symptoms such as a skin rash, fever, and aches in the joints and muscles usher.Latent Stage
In latent stage, the symptoms eventually disappear (in about 4 to 12 weeks), and the disease ceases to be infectious, but a blood test for the presence of the bacteria generally remains positive. During this “Symptomless” period, the bacteria may invade body organs.Tertiary Stage
In the tertiary stage, signs of organ degeneration appear.
If the syphilis bacteria attack the organs of the nervous system, the tertiary stage is called neuro–syphilis. Neurosyphilis may take different forms, depending on the tissue involved. For instance, about two years after the onset of the disease, the bacteria may attack the meninges, producing meningitis. The blood vessels that supply the brain may also become infected. In this case, symptoms depend on the parts of the brain destroyed by oxygen and glucose starvation. Cerebellar damage is manifested by un–coordinated movements in such activities as writing. As the motor areas become extensively damaged, victims may be unable to control urine and bowel movements. Eventually, they may become bedridden, unable even to feed themselves. Damage to the cerebral cortex produces memory loss and personality changes that range from irritability to hallucinations.During Pregnancy
Infection of the fetus with syphilis can occur after the fifth month. Infection of the mother is not necessarily followed by fetal infection, provided that the placenta remains intact. But once the bacteria gains access to fetal circulation, there is nothing to hinder their growth and multiplication. As many as 80 percent of children born to untreated syphilitic mothers will be infected in the uterus if the fetus is exposed at the onset or in the early stages of the disease. About 25 percent of the fetuses will die within the uterus. Most of the survivors will arrive prematurely, but 30 percent will die shortly after birth. Of the infected and untreated children surviving infancy, about 40 percent will develop symptomatic syphilis during their lifetimes.Treatment of Syphilis
Syphilis can be treated with antibiotics during the primary, secondary, and latent periods. Certain forms of neurosyphilis may also be successfully treated, but the prognosis for others is very poor. Noticeable symptoms do not always appear during the first two stages of the disease. Syphilis, however, is usually diagnosed through a blood test whether noticeable symptoms appear or not. Some evidence suggests that AIDS may alter the course of neurosyphilis by accelerating its progression, possibly by impairing macrophages and antibody production and facilitating penetration of the AIDS virus into the central nervous system.

Genital Herpes
Unlike syphilis and gonorrhea, genital herpes is incurable. Type I herpes simplex virus is the virus that causes the majority of infections above the waist such as cold sores. Type II herpes simplex virus causes most infections below the waist such as painful genital blisters on the prepuce, glands, penis, and penile shaft in males and on the vulva or sometimes high up in the vagina in females. The blisters disappear and reappear in most patients, but the virus itself remains in the body. Genital herpes virus infection causes considerable discomfort, and there is an extraordinarily high rate of recurrence of the symptoms. The infection is usually characterized by fever, chills, flu like symptoms, lymphadenopathy, and numerous clusters of genital blisters. For pregnant women with genital herpes symptoms at the time of delivery, a cesarean section will usually prevent complications in the child. Complications range from central nervous system damage to death.Treatment of Genital Herpes
Pain medication, saline compresses, sexual abstinence for the duration of the eruption, and use of some oral drugs. These drugs interfere with viral DNA replication but not with host cell DNA replication. A topically applied ointment that contains Inter Vir–A (Immuvir), an antiviral substance, is another drug used to treat genital herpes. Inter Vir–A provides rapid relief for the pain, itching, and burning associated with genital herpes. An experimental genital herpes vaccine will involve human testing shortly.

Chlamydia
Chlamydia (kla–MID–e–a) is a sexually transmitted infection caused by the bacterium Chlamydia Trachomatis (chlamys = cloak, the bacterium cannot grow outside the body; it cloaks itself inside cells to divide). At present, chlamydia is the most prevalent and one of the most damaging of the sexually transmitted infections. It affects between 3 and 5 million persons annually.In Males
Urethritis (inflammation of the urethra) is the principal result. It is characterized by burning on urination, frequency of urination, painful urination, and low back pain.In Females
Urethritis may spread through the reproductive tract and develop into inflammation of the uterine (Fallopian) tubes, which increases the risk of ectopic pregnancy and sterility. As in gonorrhea, the organism may be passed from mother to infant during childbirth, infection the eyes. Treatment consists of the administration of specific antibiotics.

Trichomoniasis
The microorganism Trichomonas vaginalis, a flagellated protozoan (one–celled animal), causes trichomoniasis, an inflammation of the mucous membrane of the vagina in females and the urethra in males. If the normal acidity of the vagina is disrupted, the protozoan may overgrow the normal microbial population and cause trichomoniasis. Symptoms include a yellowish vaginal discharge with a particularly offensive odor and severe vaginal itch in women. Men can have it without symptoms but can transmit it to women none–the–less.Treatment of Trichomoniasis
Sexual partners must be treated simultaneously. The drug of choice is metronidazole.

Genital Warts
Warts are an infectious disease caused by viruses. Sexual transmission of genital warts is common and is caused by the Human Papilloma Virus (HPV). It is estimated that nearly 1 million persons a year develop genital warts. Patients with a history of genital warts may be at increased risk for certain types of cancer (cervical, vaginal, anal, vulval, and penile). There is no cure for genital warts.Treatment of Genital Warts
It consists of cryotherapy with liquid nitrogen, electrocautery, excision, laser surgery, and topical application of podophyllin in tincture of benzoin. Alpha interferon is also used to treat genital warts.

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